What to Expect When Changing Billing Systems

One of the biggest decisions that HME providers face is picking the right billing system for their company. While there has been some consolidation in the HME billing software space, there are still many options in the market, each having unique strengths. At Medtrade 2018, I moderated a panel discussion of providers who recently made this important decision. The panelists:

• Chris Kinard, vice president of Corporate Systems for LifeH2H in Columbia, South Carolina. This company recently made the decision to move forward with the Universal Software Solutions HDMS system. They chose custom programming to help track patient outcomes, an integral part of their hospital to home (H2H) line of business.
   
• Aleshia Polk, director of Reimbursement Operations for ZOLL LifeVest in Pittsburgh, Pennsylvania. Polk’s company recently implemented Brightree after going through an exhaustive search that spanned two years.
   
• Carmen Vasquez, partner consultant with HME360 Consulting in St. Louis, Missouri. Vasquez is currently working with multiple HME clients in various phases of the billing system selection process and was a system implementer for Fastrack several years ago. More recently, Vasquez has worked with the HDMS and Bonafide billing systems on major implementations.

The panel discussion was focused around four primary questions:

1. When is the right time to start looking for a new HME billing system?
    
2. What are the most important features and benefits to evaluate when reviewing systems?
    
3. What are some best practices for the system selection process?
    
4. Why did you select the system that you selected, and what most influenced your final decision?
    

When is the right time to start looking for a new billing system?

There are several factors that would influence the decision to begin searching for a new HME billing system. Many providers are still operating on old or antiquated systems—while they may work today, the major issue here is the companies that created them may no longer be supporting or investing in new development. This may apply to several commercial systems as well as many proprietary systems.

Another major reason to start looking is a general lack of satisfaction with a current system, primarily because it is not supporting the provider’s business goals. For example, the current system may not support a complex workflow management process or may not have the right checks and balances to prevent “bad” orders from going out the door. In addition, some systems do not support the size and scale of the business, and it can take hours to perform simple tasks such as creating reports, posting orders and invoices, or closing the month. Or, these systems may not have the proper integration points with the provider’s ancillary software systems. Examples of this include the suite of PAP compliance monitoring solutions, document management and/or workflow management, or accounting/general ledger systems.

However, any provider who says that implementing a new billing system is not disruptive to productivity and cash flow is sugarcoating the truth, at best. Expect the process to take a minimum of 90 days to implement and cost your team not only thousands of dollars in investment, but also hundreds of work hours. Providers who are experiencing cash flow issues or staffing issues would be better served focusing their attention on these matters before embarking on new system implementation.

What are the most important features and benefits to evaluate?

Every system in the market has the ability to generate HME claims, transmit them to insurance companies and pull back electronic remittance files to be auto-posted, so these abilities are not differentiating. There are, however, many features and benefits that are differentiating, and each provider should analyze these to determine what is more important for their business strategy.

One feature to consider is whether the system is SAAS (hosted in the cloud) or on-premise. Some providers, especially large health systems, mandate that billing systems must be on-premise; this feature alone will eliminate 50 percent of the choices in the market.

Another key feature is the availability of custom programming; some systems do not support it.

An Application Programming Interface (API) is another key feature because it determines the billing system’s ability to be integrated with other systems. Modern providers are hungry for as much automation as possible so the level of automation in the day-to-day process is critical.

Workflow management, especially when it is fully integrated with documents, is another very important feature to consider.

Finally, data access and reporting abilities are critical as well. It should also be noted that the software vendor’s market knowledge and experience, as well as their implementation and training package, can make or break a provider’s decision.

What are some best practices for choosing a billing system?

While each provider will have its own unique selection process, there are several aspects on which everyone agrees.

First, develop a formal request for proposal (RFP) process, and engage all major vendors in the space. As part of this RFP, identify what features and benefits are critical for your business. This helps to quickly eliminate non-conforming systems. Next, evaluate the vendors individually—look to see that the vendor is a good long-term business partner. It’s not enough to simply demo each system. Once you have short-listed a few options, schedule a site visit to see those systems in action at a provider. Finally, while price is important, you get what you pay for, and none of the panel providers believe that you should choose a system based on price alone.

What influenced the final decision?

Not one provider reported that price was a major factor in their final decision. Instead, the most important factor is the availability of those business-critical features and benefits as well as faith in the software vendor’s ability to be a good long-term business partner with strong implementation and training to accompany the software purchase. Panelists cited system flexibility and data access as major features and benefits.

What advice would you give to a provider who is just starting this journey? First, take your time—but don’t get stuck in paralysis by analysis. If necessary, seek professional help, such as a consultant. It is important to recognize that you will have to change your internal processes to fit your new system, and you will never find a system that checks all the boxes. Trying to force your new software to operate the same as your old software is a certain path to failure.

Recognize that this is not a small undertaking and plan accordingly—you will have to provide the necessary resources (time and money) to make it successful. Do not cut corners on the implementation or training. As one panelist said, “I have never seen a provider buy too many training hours.”